Greetings, loyal readers, editor Kevin here to introduce the first of a series of three articles examining the history of mental health treatment for women in the 19th century written by Center for Education summer intern Isabel DuBois. We're thankful for her hard work researching and preparing these pieces.
Take it away, Isabel.
Most people associate the word “asylum” with squalor and brutality—an impression strengthened by portrayals in books and films like One Flew Over the Cuckoo’s Nest and American Horror Story: Asylum—but they were originally designed to be places of sanctuary. With the 18th century came a public commitment to mental health treatment, and charity became a staple of modern life. Liberal-minded reformers called for the “insane” to be placed into care facilities instead of being jailed, and thus the asylum was born. For many years, these facilities were considered to be the pinnacle of mental health care, providing housing, food and medical care for people in need. However, around the mid-19th century, insane asylums began to decline. As patients with incurable illnesses filled them, asylums became warehouses for people who could not be maintained elsewhere. Many asylums began to face the same problems, namely overcrowding and lack of funding, as facilities originally designed to hold smaller numbers of patients began to fill up, often nearly doubling in population and placing intense strain on infrastructure. These issues led to the placement of many patients in poorhouses and to unhealthy and unsafe conditions at the asylums. Many superintendents including Dr. Edward Runge, the superintendent at the Saint Louis Asylum, tried to counteract this trend of decline, but the asylums, at that time, were able to offer little more than custodial care to their many patients.
In response, celebrities of the day began speaking out about the harsh conditions in insane asylums and poorhouses. Amongst these celebrities, one of the most outspoken was Charles Dickens. His 1857 publication entitled “The Star of Bethlehem” was one of his many works criticizing the current standard of care. In it, Dickens recounts the history of the St. Mary of Bethlehem hospital in London, a facility that housed the insane and mentally ill. Dickens described the hospital as a “foul, wretched place” and called for institutional reform to make the living conditions tolerable for its patients.
An unlikely advocate for change came through the work of one young journalist, Nellie Bly, who made a name for herself in the late 1800s with a series of articles about living life as a sane woman in Bellevue Hospital’s insane ward on Blackwell’s Island. Just 23, Bly was one of a handful of female reporters in New York City. For years, rumors had swirled about conditions in one of the city’s most notorious places: the insane asylum on Blackwell’s Island. Now known as Roosevelt Island, Blackwell’s Island was home to a number of public institutions, including a penitentiary, a poorhouse, hospitals for infectious diseases like smallpox, and the asylum. These articles would later be compiled into her 1887 book entitled “ Of the many obstacles Bly faced in going undercover and getting committed to Bellevue, the one she found most daunting was whether or not she had the ability to deceive the insanity experts. In order to avoid the trouble of the experts, she chose to be committed by way of the courts. She need not have worried, though. In a journey that took less than 3 days, she set out to prove herself insane. She wandered the halls and nearby streets, refused to sleep, ranted and yelled incoherently, and even practiced looking “crazed” in her mirror. Within days, the boarding house owners summoned the police. Bly, now claiming to be a Cuban immigrant, suffering from amnesia was sent by a perplexed judge to Bellevue Hospital. Her time at Bellevue was quick to acclimate her to the suffering to come, as hospital inmates were forced to eat spoiled food and lived in squalid conditions. When Bly was diagnosed with dementia and other psychological illnesses, she was sent by ferry to Blackwell’s Island, in the East River.
Originally built to hold 1,000 patients, Blackwell was cramming more than 1,600 people into the asylum when Bly arrived in the fall of 1887. Like many such institutions, extensive budget cuts had led to a sharp decline in patient care. In the case of Bellevue, this left just 16 doctors on staff to care for the 1,600 patients.
Most disturbing of all, even to those most accustomed to the medical practices of the day, was the prevailing wisdom of the age regarding both the causes of mental illness and how patients should be treated. Asylums like Blackwell's Island were considered curiosities, where thrill seekers and others could visit those thought to be “mad.” Doctors and staff with little training—and in many cases, little compassion—ordered harsh and brutal treatments that did little to heal and much to harm. Bly quickly befriended her fellow inmates, who revealed rampant psychological and physical abuse. Patients were forced to take ice-cold baths and remain in wet clothes for hours, leading to frequent illnesses. They were forced to sit still on benches, without speaking or moving, for stints lasting 12 hours or more. Some patients were tethered together with ropes and forced to pull carts around like mules. Food and sanitary conditions were horrific, with rotten meat, moldy, stale bread, and frequently contaminated water dished out. Those who complained or resisted were beaten, and Bly even spoke of the threat of sexual violence by many of the tyrannical staffers.
What shocked Bly even more than the treatments was the fact that many of the patients were, in fact, not insane at all. Rather, many were recent immigrants, mostly women, caught up in a law-enforcement system in which they were unable to communicate. Others had fallen through the cracks of a society and, with few social safety nets, ended up committed simply for being poor with no family to support them. Bly quickly realized that while many of these inmates were not suffering from mental illnesses before they arrived at the asylum, the treatments had inflicted grave psychological damage on them; stating, “I would like the expert physicians who are condemning me for my action, which has proven their ability, to take a perfectly sane and healthy woman, shut her up and make her sit from 6 A. M. until 8 P. M. on straight-back benches, do not allow her to talk or move during these hours, give her no reading and let her know nothing of the world or its doings, give her bad food and harsh treatment, and see how long it will take to make her insane. Two months would make her a mental and physical wreck.”
A month after Bly’s articles were published, a grand-jury panel visited the asylum to investigate. Unfortunately, the hospital and its staff had been tipped off in advance. By the time the jury members arrived, the asylum had cleaned up its act, literally. Many of the inmates who had provided Bly with details of their horrific treatment had been released or transferred. The staff denied Bly’s accounts. Fresh food and water had been brought in, and the asylum itself had been scrubbed down. Despite this effort at a cover-up, the grand jury agreed with Bly. A bill that was already under consideration, which would increase funding for mental institutions, was pushed through, adding nearly $1 million ($24 million in today’s money) to the departmental budget. Abusive staff members were fired, translators were hired to assist immigrant patients, and changes were made to the system to help prevent those who did not actually suffer from mental illness from being committed.
Thank you, Isabel, for your insights. If you are looking to learn more about the history of mental health, check out our article on Victorian Rest Cures, written by a student in the George and Judy Wohlreich Junior Fellows program. Be sure to check back next week for Isabel's next article.
Sources:
Gibson, Brian. What the Dickens? October 22, 2015. Accessed August 19, 2021.
Hatton, Timothy J. The Economic Journal 119, No. 535. February 2009: F183-F213.
Hensley, Melissa A. Missouri Medicine 107. No. 6. November-December 2010: 410-415.